Auto Owners loses causation defense to PIP claim; providers allowed to recover their full bills
Kyle Oostdyk suffered a seizure on a school bus. The driver opted to return to the school for treatment, by which time Oostdyk had suffered severe hypoxia or anoxia and catastrophic brain damage. Several doctors testified that his profound brain damage and expensive medical needs were caused by his inverted position on the bus after the seizure, which limited oxygen intake. Other doctors retained by the insurer testified that Oostdyk's injuries were caused solely by his epileptic seizure and therefore unrelated to his presence in the bus.
The jury ultimately chose to believe the treating doctors and the family's expert witnesses and awarded No Fault PIP benefits (i.e., medical care expenses, in this case). Auto Owners appealed, arguing that it should have been granted summary disposition because no motor vehicle was involved in causing the injuries. The higher court rejected this claim, pointing out that the jury had sufficient expert testimony to support its verdict.
Auto Owners also argued that the medical providers could not intervene in the case to collect full payment of their bills, because they had "accepted" partial payment by Medicaid and had not sued within one year. The Court rejected this argument, also, pointing out that the "one year back" rule applies only if neither the provider nor the victim institutes suit; the providers were legally allowed to "piggyback" their claims on the victim's lawsuit. Nor were the providers limited to the small Medicaid payments that they had mistakenly accepted, since that outcome would encourage insurers to delay payment and deny claims.